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1.
Cancers (Basel) ; 15(15)2023 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-37568576

RESUMO

BACKGROUND: The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the 'desirable' or 'ideal' postoperative clinical and oncological outcomes from both a patient's and doctor's point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. METHODS: We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized-no conversion to open, no complication with a Clavien-Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of "ideal" practice called textbook oncological outcomes. RESULTS: A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. CONCLUSIONS: Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.

2.
Langenbecks Arch Surg ; 408(1): 175, 2023 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-37140753

RESUMO

PURPOSE: Laparoscopic ileal pouch-anal anastomosis (IPAA) surgery offers improved short-term outcomes over open surgery but can be technically challenging. Robotic surgery has been increasingly used for IPAA surgery, but there is limited evidence supporting its use. This study aims to compare the short-term outcomes of laparoscopic and robotic IPAA procedures. METHODS: All consecutive patients receiving laparoscopic and robotic IPAA surgery at 3 centres, from 3 countries, between 2008 and 2019 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for gender, previous abdominal surgery, ASA grade (I, II vs III, IV) and procedure performed (proctocolectomy vs completion proctectomy). Their short-term outcomes were examined. RESULTS: A total of 89 patients were identified (73 laparoscopic, 16 robotic). The 16 patients that received robotic surgery were matched with 15 laparoscopic patients. Baseline characteristics were similar between the two groups. There were no statistically significant differences in any of the investigated short-term outcomes. Length of stay trend was higher for laparoscopic surgery (9 vs 7 days, p = 0.072) CONCLUSION: Robotic IPAA surgery is safe and feasible and offers similar short-term outcomes to laparoscopic surgery. Length of stay may be lower for robotic IPAA surgery, but further larger scale studies are required in order to demonstrate this.


Assuntos
Colite Ulcerativa , Bolsas Cólicas , Laparoscopia , Proctocolectomia Restauradora , Procedimentos Cirúrgicos Robóticos , Humanos , Proctocolectomia Restauradora/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Pontuação de Propensão , Bolsas Cólicas/efeitos adversos , Colite Ulcerativa/cirurgia , Resultado do Tratamento , Laparoscopia/métodos , Anastomose Cirúrgica/métodos , Complicações Pós-Operatórias/etiologia
3.
J Clin Med ; 11(17)2022 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-36078996

RESUMO

Background: Enhanced or accelerating recovery programs have significantly reduced hospital length stay after elective colorectal interventions. Our work aims at reporting an initial experience with ambulatory laparoscopic colectomy (ALC) to assess the criteria of discharge and outcomes. Methods: Between 2006 and 2016, data regarding patients having benefited from elective laparoscopic colorectal resections in two main centres in the United Kingdom have been analysed. Both benign and malignant pathologies were included. A standardised enhanced recovery program was performed for each patient, except epidural analgesia was replaced with single shot spinal infiltration. Patients were followed up through a telephone call system by a nurse. Short-term clinical outcomes were analysed. Results: A total of 833 patients were included and 51 (6.1%) were discharged within 24 h following surgery. Of these, 4 out of 51 (7.8%) patients came back hospital within 30 days of discharge; 2 (3.9%) required reoperation (Small bowel obstruction and wound abscess drainage). Conclusions: This study highlights that a 24-h discharge following elective laparoscopic colorectal interventions seems safe and feasible in selected patients. Although challenging to achieve, a standardised approach to laparoscopic surgery in combination with strict adherence to an enhanced recovery protocol are the fundamental elements of this path.

4.
Ann Coloproctol ; 38(4): 307-313, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34399445

RESUMO

PURPOSE: This study was aimed to assess the feasibility of laparoscopic rectal surgery, comparing quality of surgical specimen, morbidity, and mortality. METHODS: Prospectively acquired data from consecutive patients undergoing laparoscopic surgery for rectal cancer, at 2 minimally invasive colorectal units, operated by the same team was included. Locally advanced rectal tumors were identified as T3B or T4 with preoperative magnetic resonance imaging scans. All the patients were operated on by the same team. The 1:1 propensity score matching was performed to create a perfect match in terms of tumor height. RESULTS: Total of 418 laparoscopic resections were performed, out of which 109 patients had locally advanced rectal cancer (LARC) and were propensity score matched with non-LARC (NLARC) patients. Median operation time was higher for the LARC group (270 minutes vs. 250 minutes, P=0.011). However, conversion to open surgery was done in 5 vs. 2 patients (P=0.445), reoperation in 8 vs. 7 (P=0.789), clinical anastomotic leak was found in 3 vs. 2 (P=0.670), and 30-day mortality rates was 2 vs. 1 (P>0.999) between LARC and NLARC, respectively. Readmission rate was higher in the NLARC group (33 patients vs. 19 patients, P=0.026), due to stoma-related issues. There was no statistically significant difference in the R0 resection between the 2 groups (99 patients in LARC vs. 104 patients in NLARC, P=0.284). CONCLUSION: This study demonstrates that standardized approach to laparoscopy is safe and feasible in LARC. Comparable postoperative short-term clinical and pathological outcomes were seen between LARC and NLARC groups.

5.
Ann Coloproctol ; 38(3): 223-229, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34167186

RESUMO

PURPOSE: Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. METHODS: Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. RESULTS: A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. CONCLUSION: This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.

6.
Surg Endosc ; 35(12): 6796-6806, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33289055

RESUMO

BACKGROUND: Despite there being a considerable amount of published studies on robotic colorectal surgery (RCS) over the last few years, there is a lack of evidence regarding RCS training pathways. This study examines the short-term clinical outcomes of an international RCS training programme (the European Academy of Robotic Colorectal Surgery-EARCS). METHODS: Consecutive cases from 26 European colorectal units who conducted RCS between 2014 and 2018 were included in this study. The baseline characteristics and short-term outcomes of cases performed by EARCS delegates during training were analysed and compared with cases performed by EARCS graduates and proctors. RESULTS: Data from 1130 RCS procedures were collected and classified into three cohort groups (323 training, 626 graduates and 181 proctors). The training cases conversion rate was 2.2% and R1 resection rate was 1.5%. The three groups were similar in terms of baseline characteristics with the exception of malignant cases and rectal resections performed. With the exception of operative time, blood loss and hospital stay (training vs. graduate vs. proctor: operative time 302, 265, 255 min, p < 0.001; blood loss 50, 50, 30 ml, p < 0.001; hospital stay 7, 6, 6 days, p = 0.003), all remaining short-term outcomes (conversion, 30-day reoperation, 30-day readmission, 30-day mortality, clinical anastomotic leak, complications, R1 resection and lymph node yield) were comparable between the three groups. CONCLUSIONS: Colorectal surgeons learning how to perform RCS under the EARCS-structured training pathway can safely achieve short-term clinical outcomes comparable to their trainers and overcome the learning process in a way that minimises patient harm.


Assuntos
Cirurgia Colorretal , Laparoscopia , Protectomia , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Fístula Anastomótica , Humanos , Tempo de Internação , Duração da Cirurgia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
7.
Langenbecks Arch Surg ; 405(5): 713, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32666404

RESUMO

The original version of this article unfortunately contained a mistake on the co-author name.

8.
Langenbecks Arch Surg ; 405(4): 479-490, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32472173

RESUMO

PURPOSE: Obesity, neoadjuvant-radiotherapy, tumour proximity to the anal verge and previous abdominal surgery are factors that might increase the intra-operative difficulty of laparoscopic rectal cancer surgery. However, whether patients with these 'high-risk' characteristics are subject to worse short- or long-term outcomes is debated. The aim of this study is to examine the short- and long-term clinical and oncological outcomes of patients receiving laparoscopic rectal surgery with any of these high-risk characteristics and compare them with patients that do not possess any of these high-risk features. METHODS: For the purpose of this study data from consecutive patients receiving laparoscopic rectal cancer resections between 2006 and 2016 from two centres were analysed. High-risk patients were defined as patients with either one of the following characteristics: BMI ≥ 30, neoadjuvant chemoradiotherapy, tumour < 8 cm from the anal verge and previous abdominal surgery. RESULTS: A total of 313 patients were identified (227 high risk, 86 low risk). Short-term outcomes were similar between the two groups with the exception of blood loss and length of stay, which were higher in the high-risk group (10 vs 2.5 ml, p = 0.045; 7 vs 5 days, p = 0.001). There were no statistically significant differences in 5-year overall survival (79.7% vs 79.8%, p = 0.757), disease-free survival (76.8% vs 69.3%, p = 0.175), distant disease-free interval (84.8% vs 79.7%, p = 0.231) and local recurrence-free interval (100%, 97.4%, p = 0.162) between the two groups. CONCLUSION: Similar short- and long-term outcomes can be achieved in high-risk and low-risk patients receiving laparoscopic rectal surgery. The presented data support the suitability of laparoscopic surgery for this group of patients.


Assuntos
Laparoscopia/efeitos adversos , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Idoso , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
9.
Int J Colorectal Dis ; 35(7): 1201, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32458393

RESUMO

The original version of this article, unfortunately, contained an error. The given names and family names of the authors were interchanged and are now presented correctly. The original article has been corrected.].

10.
Int J Colorectal Dis ; 35(7): 1193-1199, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32144531

RESUMO

PURPOSE: Pilonidal sinus disease (PD) is a common acquired disease, responsible for discomfort and time off work. There is currently no consensus on the best surgical therapy. We aimed at comparing conservative sinusectomy (S) to excision and paramedian primary closure (PC). METHODS: This is a randomized controlled trial compatible with the CONSORT statement standards. We included all patients with chronic PD between 2012 and 2017. We excluded patients with acute abscesses, recurrent PD after surgery with a curative intent and patients needing complex reconstructions with rotation flaps. Patients with chronic symptomatic PD were randomized to S or PC. Primary end-point was the rate of patients healed at 3 weeks, secondary outcomes were total healing time, pain, time off work, patient satisfaction and recurrence at 1 year. Patients were seen at a wound clinic until healed and contacted at 3, 6, and 12 months for follow-up. RESULTS: After inclusion of 58 patients the study was stopped prematurely due to discrepancy between expected and observed outcomes. Only 4/30 (13.3%) patients in the S group had healed completely at 3 weeks compared with 14/28 (50%) in the PC group (p = 0.01). Median time to complete healing was 54 (23-328) days in the S group compared to 34 (13-141) in the PC group (p = 0.025). Number of outpatient visits, time off work, analgesia requirement, and recurrence rates at 12 months 4 (16%) in the S group and 3 (11.1%) in the PC group (p = 0.548) were similar. CONCLUSIONS: PC leads to faster healing compared to S, with similar healthcare burden. TRIAL REGISTRATION: The study was approved by the local ethics committee and registered in www.clinicaltrials.gov (REF: NCT03271996). The study was carried out at the Regional Hospital of Lugano, Switzerland.


Assuntos
Seio Pilonidal , Humanos , Recidiva Local de Neoplasia , Seio Pilonidal/cirurgia , Recidiva , Retalhos Cirúrgicos , Suíça , Resultado do Tratamento , Cicatrização
11.
Langenbecks Arch Surg ; 403(6): 749-760, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29926187

RESUMO

PURPOSE: A structured training programme is essential for the safe adoption of robotic rectal cancer surgery. The aim of this study is to describe the training pathway and short-term surgical outcomes of three surgeons in two centres (UK and Portugal) undertaking single-docking robotic rectal surgery with the da Vinci Xi and integrated table motion (ITM). METHODS: Prospectively, collected data for consecutive patients who underwent robotic rectal cancer resections with the da Vinci Xi and ITM between November 2015 and September 2017 was analysed. The short-term surgical outcomes of the first ten cases of each surgeon (supervised) were compared with the subsequent cases (independent). In addition, the Global Assessment Score (GAS) forms from the supervised cases were analysed and the GAS cumulative sum (CUSUM) charts constructed to investigate the training pathway of the participating surgeons. RESULTS: Data from 82 patients was analysed. There were no conversions to open, no anastomotic leaks and no 30-day mortality. Mean operation time was 288 min (SD 63), median estimated blood loss 20 (IQR 20-20) ml and median length of stay 5 (IQR 4-8) days. Thirty-day readmission and reoperation rates were 4% (n = 3) and 6% (n = 5) respectively. When comparing the supervised cases with the subsequent solo cases, there were no statistically significant changes in any of the short-term outcomes with the exception of mean operative time, which was significantly shorter in the independent cases (311 vs 275 min, p = 0.038). GAS form analysis and GAS CUSUM charting revealed that ten proctoring cases were enough for trainee surgeons to independently perform robotic rectal resections with the da Vinci Xi. CONCLUSIONS: Our results show that by applying a structured training pathway and standardising the surgical technique, the single-docking procedure with the da Vinci Xi is a valid, reproducible technique that offers good short-term outcomes in our study population.


Assuntos
Adenocarcinoma/cirurgia , Educação/normas , Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/normas , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Idoso , Competência Clínica , Terapia Combinada , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Portugal , Neoplasias Retais/diagnóstico , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Reino Unido
12.
Int J Colorectal Dis ; 33(8): 1079-1086, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29577170

RESUMO

PURPOSE: Laparoscopic rectal surgery in obese patients is technically challenging. The technological advantages of robotic instruments can help overcome some of those challenges, but whether this translates to superior short-term outcomes is largely unknown. The aim of this study is to compare the short-term surgical outcomes of obese (BMI ≥ 30) robotic and laparoscopic rectal cancer surgery patients. METHODS: All consecutive obese patients receiving laparoscopic and robotic rectal cancer resection surgery from three centres, two from the UK and one from Portugal, between 2006 and 2017 were identified from prospectively collated databases. Robotic surgery patients were propensity score matched with laparoscopic patients for ASA grade, neoadjuvant radiotherapy and pathological T stage. Their short-term outcomes were examined. RESULTS: A total of 222 patients were identified (63 robotic, 159 laparoscopic). The 63 patients who received robotic surgery were matched with 61 laparoscopic patients. Cohort characteristics were similar between the two groups. In the robotic group, operative time was longer (260 vs 215 min; p = 0.000), but length of stay was shorter (6 vs 8 days; p = 0.014), and thirty-day readmission rate was lower (6.3% vs 19.7%; p = 0.033). CONCLUSIONS: In this study population, robotic rectal surgery in obese patients resulted in a shorter length of stay and lower 30-day readmission rate but longer operative time when compared to laparoscopic surgery. Robotic rectal surgery in the obese may be associated with a quicker post-operative recovery and reduced morbidity profile. Larger-scale multi-centre prospective observational studies are required to validate these results.


Assuntos
Laparoscopia , Obesidade/complicações , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
13.
Eur J Surg Oncol ; 44(4): 484-489, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29398323

RESUMO

AIMS: In rectal cancer, increasing the interval between the end of neoadjuvant chemoradiotherapy (CRT) and surgery could improve the pathological complete response (pCR) rates, allow full-dose neoadjuvant chemotherapy, and select patients with a clinical complete response (cCR) for inclusion in a "watch & wait" program (W&W). However, controversy arises from waiting more than 8-12 weeks after CRT, as it might increase fibrosis around the total mesorectal excision (TME) plane potentially leading to technical difficulties and higher surgical morbidity. This study evaluates the type of surgical approach and short term post-operative outcomes in patients with rectal cancer that were operated before and after 12 weeks post CRT. METHODS: Patients from three centres (two in the UK, one in Portugal) who received rectal cancer surgery following neoadjuvant CRT between 2007 and 2016 were identified from prospectively maintained databases. Preoperative CRT was given to patients with high risk for local recurrence (threatened CRM ≤2 mm or T4 in staging MRI). The baseline characteristics and surgical outcomes of patients that were operated <12 weeks and ≥12 weeks after finishing CRT were analysed. RESULTS: A total of 470 patients received rectal cancer surgery, of those 124 (26%) received neoadjuvant CRT. Seventy-six patients (61%) were operated ≥12 weeks after end of neoadjuvant-CRT and 48 < 12 weeks. Patients in the ≥12 weeks cohort had a higher BMI (27 vs 25, p = 0.030) and lower lymph node yield (11 vs 14, p = 0.001). The remaining of the baseline characteristics were similar between the two groups (age, operating surgeon, gender, ASA grade, T stage, surgical approach, operation). Operation time, blood loss, conversion rate, length of stay, 30-day readmission rate, 30-day reoperation rate, anastomotic leak rate, 30-day mortality, CRM clearance, and ypT0 rates were similar between the two groups. Univariate and multivariate analysis showed that delaying surgery ≥12 weeks did not affect morbidity and mortality. CONCLUSION: In our cohort, there was no difference in short term surgical outcomes between patients operated before or after 12 weeks following CRT. The type of surgical procedures and the proposed approach did not differ due to waiting after CRT. Delaying surgery by ≥ 12 weeks is safe, feasible and does not result in higher surgical morbidity.


Assuntos
Quimiorradioterapia Adjuvante , Procedimentos Cirúrgicos do Sistema Digestório , Terapia Neoadjuvante , Neoplasias Retais/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Neoplasias Retais/patologia , Fatores de Tempo , Resultado do Tratamento , Reino Unido , Conduta Expectante
14.
Surg Endosc ; 32(8): 3486-3494, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29362912

RESUMO

BACKGROUND: As obesity becomes more prevalent, it presents a technical challenge for minimally invasive colorectal resection surgery. Various studies have examined the clinical outcomes of obese surgical patients. However, morbidly obese patients (BMI ≥ 35) are becoming increasingly more common. This study aims to investigate the short-term surgical outcomes of morbidly obese patients undergoing minimal-invasive colorectal surgery and compare them with both obese (30 ≤ BMI < 35) and non-obese patients (BMI < 30). METHODS: Patients from three centres who received minimally invasive colorectal surgical resections between 2006 and 2016 were identified from prospectively collected databases. The baseline characteristics and surgical outcomes of morbidly obese, obese and non-obese patients were analysed. RESULTS: A total of 1386 patients were identified, 84 (6%) morbidly obese, 246 (18%) obese and 1056 (76%) non-obese. Patients' baseline characteristics were similar for age, operating surgeon, surgical approach but differed in terms of ASA grade and gender. There was no difference in conversion rate, length of stay, anastomotic leak rate and 30-day readmission, reoperation and mortality rates. Operation time and blood loss were different across the 3 groups (morbidly obese vs obese vs non-obese: 185 vs 188 vs 170 min, p = 0.000; 20 vs 20 vs 10 ml, p = 0.003). In patients with malignant disease there was no difference in lymph node yield or R0 clearance. Univariate and multivariate linear regression analysis showed that for every one-unit increase in BMI operative time increases by roughly 2 min (univariate 2.243, 95% CI 1.524-2.962; multivariate 2.295; 95% CI 1.554-3.036). Univariate and multivariate binary logistic regression analyses showed that BMI does not affect conversion or morbidity and mortality. CONCLUSIONS: The increased technical difficulty encountered in obese and morbidly obese patients in minimally invasive colorectal surgery results in higher operative times and blood loss, although this is not clinically significant. However, conversion rate and post-operative short-term outcomes are similar between morbidly obese, obese and non-obese patients.


Assuntos
Índice de Massa Corporal , Colectomia/métodos , Doenças do Colo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Obesidade Mórbida/complicações , Protectomia/métodos , Doenças Retais/cirurgia , Adulto , Idoso , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Estudos de Casos e Controles , Doenças do Colo/complicações , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Duração da Cirurgia , Doenças Retais/complicações , Estudos Retrospectivos , Resultado do Tratamento
15.
J Robot Surg ; 12(3): 433-436, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28916892

RESUMO

Robotic rectal surgery is becoming increasingly more popular among colorectal surgeons. However, time spent on robotic platform docking, arm clashing and undocking of the platform during the procedure are factors that surgeons often find cumbersome and time consuming. The newest surgical platform, the da Vinci Xi, coupled with integrated table motion can help to overcome these problems. This technical note aims to describe a standardised operative technique of single docking robotic rectal surgery using the da Vinci Xi system and integrated table motion. A stepwise approach of the da Vinci docking process and surgical technique is described accompanied by an intra-operative video that demonstrates this technique. We also present data collected from a prospectively maintained database. 33 consecutive rectal cancer patients (24 male, 9 female) received robotic rectal surgery with the da Vinci Xi during the preparation of this technical note. 29 (88%) patients had anterior resections, and four (12%) had abdominoperineal excisions. There were no conversions, no anastomotic leaks and no mortality. Median operation time was 331 (249-372) min, blood loss 20 (20-45) mls and length of stay 6.5 (4-8) days. 30-day readmission rate and re-operation rates were 3% (n = 1). This standardised technique of single docking robotic rectal surgery with the da Vinci Xi is safe, feasible and reproducible. The technological advances of the new robotic system facilitate the totally robotic single docking approach.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias Retais/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Posicionamento do Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/mortalidade , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
16.
Int J Surg ; 47: 69-76, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28951290

RESUMO

BACKGROUND: Laparoscopic surgery for patients with Crohn's disease (CD) is considered challenging. The aim of this study is to evaluate the clinical outcomes of laparoscopic bowel resection in patients with CD. We also assessed the effectiveness of the laparoscopic approach in recurrent or emergency surgery due to CD. MATERIALS AND METHODS: All patients with CD, who underwent laparoscopic resection surgery in two units from October 2006 to February 2016, were identified through prospectively maintained databases. Their baseline characteristics and perioperative outcomes were analysed. The outcomes of patients receiving primary vs recurrent and elective vs emergency laparoscopic resections for CD were also examined. RESULTS: In total 106 patients underwent laparoscopic resection. Primary ileocolic resection was the most frequent procedure (62%) followed by redo-ileocolic resection (15%). Overall conversion rate was 4.7%, median operative time was 130 (95-185) minutes and length of stay was 4 days (3-6). There was one anastomotic leak (1.1%) and 30-day re-operation rate was 5.7%. Patients having primary resections were younger and had a shorter length of stay (4 vs 5 days; p = 0.014). Thirty day re-operation rate was higher in patients having emergency surgery (3.1% vs 30%; p = 0.011). CONCLUSIONS: This case series demonstrates that laparoscopic resection surgery for CD is safe and feasible. Similarly, laparoscopic surgery is also a viable option for patients having recurrent resection and possibly even emergency surgery.


Assuntos
Doença de Crohn/cirurgia , Laparoscopia/métodos , Adulto , Fístula Anastomótica/cirurgia , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação
17.
Surg Endosc ; 31(10): 4067-4076, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28271267

RESUMO

BACKGROUND: The learning curve for robotic colorectal surgery is ill-defined. This study aimed to investigate the learning curve of experienced laparoscopic rectal surgeons when starting with robotic total mesorectal excision (TME) using cumulative sum (CUSUM) charts. METHODS: This retrospective case series analysed patients who underwent curative and elective laparoscopic or robotic TMEs for rectal cancer performed by two surgeons. The first consecutive robotic TME cases of each surgeon were 1:1 propensity score matched to their laparoscopic TME cases using age, body mass index, American Society of Anesthesiologists grade, T stage (AJCC) and tumour location height. The matched laparoscopic cases defined individual standards for the quality indicators: operating time, R stage, lymph node harvest, length of hospital stay and major complications (Clavien-Dindo grade 3-5). Deviation of more than a quarter of a standard deviation from the mean for the continuous indicators, or exceeding the observed risk for the binary indicators was defined as off-target with an upward inflection in the CUSUM curve. RESULTS: From 2006 to 2015, 384 (294 laparoscopic; 90 robotic) TMEs met the inclusion criteria. Surgeon A performed 206 (70.1%) of the laparoscopic and 43 (47.8%) of the robotic cases. Surgeon B performed 88 (29.9%) of the laparoscopic and 47 (52.2%) of the robotic cases. After matching, no covariate exhibited an absolute standardised mean difference >0.25. For surgeon A, the CUSUM curves showed no apparent learning process compared to his laparoscopic standards. For surgeon B, a learning process for operation time, lymph node harvest and major complications was demonstrated by an initial upward inflection of the CUSUM curves; after 15 cases, all quality indicators were generally on target. CONCLUSIONS: For experienced laparoscopic colorectal surgeons, the formal learning process for robotic TME may be short to reach a similar performance level as obtained in conventional laparoscopy.


Assuntos
Competência Clínica/estatística & dados numéricos , Cirurgia Colorretal/educação , Laparoscopia/educação , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/educação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cirurgia Colorretal/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Curva de Aprendizado , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões/educação
18.
Scott Med J ; 62(1): 11-15, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28110628

RESUMO

Background and aims Sublingual glyceryl trinitrate has been used as an aid to cannulate the Sphincter of Oddi during endoscopic retrograde cholangiopancreatography. Its role in terminal ileal intubation during colonoscopy is unknown. This study examines the role of sublingual glyceryl trinitrate in terminal ileal intubation during colonoscopy. Methods A triple-blind randomized controlled trial comparing sublingual glyceryl trinitrate (800 µg) vs. placebo (saline) in relation to terminal ileal intubation during colonoscopy was performed. Following caecal intubation, participants received sublingual glyceryl trinitrate/placebo followed by a 2-min observation period before intubation was attempted. Data on time to intubate the terminal ileum and intubation rate were collected. Results A total of 110 patients (age: 58 years (18-75)) were recruited and randomised as per protocol: 54 received sublingual glyceryl trinitrate. Terminal ileal intubation was successful in all patients receiving sublingual glyceryl trinitrate and in 53 (94.6%) of those receiving saline ( p = 0.243: Fischer's exact). The median time taken for ileal intubation after application of spray was 72.5 (7-900) s in the glyceryl trinitrate group compared with 125 (5-900) s in the placebo group ( p = 0.150: Mann-Whitney). There were no major adverse events reported in either group. Conclusions Terminal ileal intubation rates and timing were very good in both groups. Routine sublingual glyceryl trinitrate was not proven to be beneficial in improving terminal ileal intubation or intubation success rates in the hands of experienced colonoscopists. However, trends in this small study might suggest that glyceryl trinitrate could be useful in the hands of less experienced colonoscopists or in difficult terminal ileal intubation cases.


Assuntos
Colonoscopia , Doenças do Íleo/terapia , Íleo/patologia , Intubação , Nitroglicerina/administração & dosagem , Nitroglicerina/uso terapêutico , Administração Sublingual , Adolescente , Adulto , Idoso , Humanos , Doenças do Íleo/patologia , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico , Adulto Jovem
19.
Int J Colorectal Dis ; 32(2): 241-248, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27770247

RESUMO

PURPOSE: Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. METHODS: Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. RESULTS: Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p < 0.001). In females, there was no difference between the two groups in any of the components of urological or sexual function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003). CONCLUSION: Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.


Assuntos
Laparoscopia , Neoplasias Retais/fisiopatologia , Neoplasias Retais/cirurgia , Robótica , Sistema Urogenital/fisiopatologia , Idoso , Demografia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/etiologia
20.
World J Gastrointest Surg ; 8(11): 744-754, 2016 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-27933136

RESUMO

AIM: To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS: A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: "rectal cancer" or "colorectal cancer" and robot* or "da Vinci" and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS: Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726 (54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and three sexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION: There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

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